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Meta-Analysis of Renal Denervation for Hypertension
Quick Takes
- Renal denervation is associated with a modest reduction in ambulatory blood pressure control (~4/2 mm Hg).
- Renal denervation is associated with a modest reduction in office blood pressure readings (~6/4 mm Hg).
- The benefits of renal denervation of blood pressure control were similar for patients with and without baseline antihypertensive medication use.
Study Questions:
What are the effects of renal denervation on the control of hypertension in patients taking and not taking antihypertensive medications?
Methods:
The authors performed a systematic literature review and meta-analysis of all blinded, placebo-controlled, randomized trials of catheter-based renal sympathetic denervation for hypertension management. The primary efficacy outcome was the change in ambulatory systolic blood pressure beyond the effects of placebo procedure. Analysis was stratified by baseline use of antihypertensive medications.
Results:
The meta-analysis included seven randomized trials of 1,368 patients. Across these trials, renal denervation was associated with a reduction in ambulatory systolic blood pressure (mean difference, -3.61 mm Hg; 95% confidence interval [CI], -4.89 to -2.33 mm Hg), ambulatory diastolic blood pressure (mean difference, -1.85 mm Hg; 95% CI, -2.78 to -0.92 mm Hg), office systolic blood pressure (-5.86 mm Hg; 95% CI, -7.77 to -3.94 mm Hg), and office diastolic blood pressure (-3.63 mm Hg; 95% CI, -4.77 to -2.50 mm Hg). Baseline antihypertensive medication use did not impact the effect size of renal denervation.
Conclusions:
The authors concluded that renal denervation significantly reduced ambulatory and office blood pressure readings as compared to placebo controls in randomized trials. They also concluded that the magnitude of blood pressure control was modest and that persistence of these changes over time remain unknown.
Perspective:
Multiple sham-controlled randomized trials have demonstrated modest benefit of renal denervation in lowering blood pressure values both for patients taking and not taking antihypertensive medications. However, these trials largely excluded patients with resistant hypertension. The largest trial of patients with resistant hypertension (SYMPLICITY HTN-3) failed to show benefit of renal denervation over a sham procedure. This meta-analysis includes the latest data from the RADIANCE-HTN TRIO trial of 136 patients with baseline antihypertensive medication use. While this meta-analysis did show statistically significant findings for both ambulatory and office blood pressure reduction, the magnitude of reduction is only modest, especially for ambulatory blood pressure values (~4/2 mm Hg reduction). As is suggested by the authors, the current evidence does not support the use of renal denervation as a ‘cure all’ for hypertension. Rather, it may serve a role for patients who have difficulty with medication adherence and/or are reluctant to increase the number of antihypertensive medications being used. However, without robust long-term data, the sustainability of these modest blood pressure reductions remains to be seen.
Clinical Topics: Diabetes and Cardiometabolic Disease, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Hypertension
Keywords: Antihypertensive Agents, Blood Pressure, Blood Pressure Monitoring, Ambulatory, Catheters, Denervation, Geriatrics, Hypertension, Kidney, Medication Adherence, Metabolic Syndrome, Primary Prevention, Sympathectomy, Systole, TCT21, Transcatheter Cardiovascular Therapeutics, Vascular Diseases
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